Rick Bonifazio: Post-Therapy Therapy

Rick Bonifazio is a clinical exercise therapist in Plainview, Long Island . He manages a gym in a private community that has a high proportion of adults over 60.

“Although the facility is a fitness studio,” he says, “I end up doing a lot of clinical work because of the age of the residents. I work with people after they have left traditional rehab. I get people after their insurance coverage has run out. I’ve worked with about 20 stroke survivors over the last seven years. With stroke it’s particularly bad because a few weeks of rehab is just the beginning for them. Because it’s so short, they don’t really get helped.

“I want to create stability and balance first,” says Rick, “so I concentrate on strengthening the core of the body — the abdominal area, lower back and muscles around the pelvis — then we branch out to other muscle groups.

“With a stroke survivor it’s usually one side or the other. You have to isolate the area that has been injured. We may start with no weight and just do range of motion exercises to wake up the muscles and the connection with the brain. Once they can go through the whole range, we add slight resistance. We concentrate on one side at a time and alternate sides every few minutes.”

Rick keeps the workouts short but with some intensity, either light weight with lots of repetitions or doing the exercise very slowly so the survivor has to concentrate on the movement. Sometimes he finds the hardest thing to do is keep the survivor from doing too much at the start and burning out.

“When I worked people too hard at first, their balance would improve, but they wouldn’t get better. It takes a while, and it’s hard to keep them motivated mentally. You have to make them notice the subtle improvements, like standing up on their own or holding a weight for 30 seconds. I just keep reminding them that small changes lead to big changes.”

For people with complete paralysis on one side, Rick tries to keep the shoulder stretched. This helps maintain good blood flow to the limb and keeps the ligaments and tendons from shrinking. “If the shoulder isn’t stretched,” he says, “they get frozen shoulder syndrome, and it’s really painful. My goal is to create flexibility in all the joints, but particularly the shoulder, hips and knees.”

Be safe! Check with your physician before starting any exercise program.